Our Summary

This research paper discusses a type of brain surgery, called awake craniotomy, where the patient is kept awake during the procedure. This method is commonly used in adults to avoid post-surgery complications when removing brain lesions near important areas of the brain. The paper notes that this method is also increasingly being used in children.

The paper specifically highlights the challenges faced by the surgical and anesthesia teams when performing this procedure on children. It presents a case study of a 9-year-old boy who underwent this surgery for the removal of a large brain tumor, focusing on his care before, during, and after the operation.

In conclusion, the paper suggests that awake craniotomies can be safely performed on children, given the right patient selection, planning, and a team-based approach.

FAQs

  1. What is an awake craniotomy and why is it used?
  2. What are the challenges faced by the surgical and anesthesia teams when performing awake craniotomy on children?
  3. Can awake craniotomies be safely performed on children?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to follow all pre-operative instructions provided by the medical team, including fasting guidelines and any medication adjustments. It is important to communicate any concerns or questions with your healthcare provider before the procedure. Additionally, following post-operative care instructions, such as taking prescribed medications and attending follow-up appointments, is crucial for a successful recovery.

Suitable For

Overall, patients who are typically recommended for craniotomy include those with brain tumors, epilepsy, traumatic brain injuries, vascular malformations, and other conditions that require surgical intervention. The decision to perform a craniotomy is based on factors such as the location and size of the lesion, the patient’s overall health, and the potential risks and benefits of surgery. Awake craniotomy may be recommended for patients with lesions located near critical areas of the brain, where preserving neurological function is crucial.

In the case of children, awake craniotomy may be recommended in specific situations where preserving neurological function is paramount, such as in the removal of tumors near eloquent areas of the brain. However, the decision to perform awake craniotomy in children must be carefully considered, taking into account the child’s age, cognitive abilities, and ability to cooperate during the procedure.

Ultimately, the recommendation for craniotomy, whether awake or under general anesthesia, is made on a case-by-case basis by a multidisciplinary team of neurosurgeons, neurologists, and other healthcare providers. The goal is to provide the best possible outcome for the patient while minimizing the risks associated with surgery.

Timeline

Before the craniotomy:

  • The patient undergoes a series of tests and evaluations to determine the extent and location of the brain lesion.
  • The patient and their family meet with the surgical team to discuss the procedure, risks, and potential outcomes.
  • The patient may undergo pre-operative preparations, such as fasting and medication adjustments.

During the craniotomy:

  • The patient is brought into the operating room and positioned on the operating table.
  • Anesthesia is administered to induce a state of sedation, but the patient remains awake and responsive during the surgery.
  • The surgical team performs the procedure to remove the brain lesion, while monitoring the patient’s neurological function and responses.

After the craniotomy:

  • The patient is moved to the recovery room for close monitoring and observation.
  • The patient may experience pain, swelling, and discomfort at the surgical site, which is managed with pain medication.
  • The patient undergoes rehabilitation and follow-up appointments to monitor their recovery and address any complications or concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about craniotomy include:

  1. Why is a craniotomy recommended for my condition?
  2. What are the potential risks and complications associated with a craniotomy?
  3. What is the success rate of this procedure for my specific condition?
  4. What is the recovery process like after a craniotomy?
  5. Will I need any additional treatments or therapies after the surgery?
  6. How long will I need to stay in the hospital after the procedure?
  7. Will I experience any cognitive or physical changes after the surgery?
  8. What type of follow-up care will I need after the surgery?
  9. Are there any alternative treatment options to consider?
  10. How experienced is the surgical team in performing craniotomies, especially in children?

Reference

Authors: Henry MN, Shahin MN, Stevens I, Calvert J, Colgan DD, Vega M, Collins K. Journal: Paediatr Anaesth. 2025 Apr;35(4):270-276. doi: 10.1111/pan.15075. Epub 2025 Feb 1. PMID: 39893509